New lung cancer screening guidelines
could cost Medicare $9.3 billion
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[May 15, 2014]
By Julie Steenhuysen
— A study of Medicare
beneficiaries with a history of heavy smoking found that new lung cancer
screening guidelines would likely double the proportion of lung cancers
found at an early stage, but at a steep cost of some $9.3 billion over
five years, U.S. researchers said on Wednesday.
The analysis, released ahead of the American Society
for Clinical Oncology meeting from May 30 to June 3 in Chicago,
estimates for the first time the cost of implementing new
recommendations released last December by the U.S. Preventive
Services Task Force.
The influential panel of independent experts, who advise U.S.
policymakers, recommended that heavy smokers and former heavy
smokers should get annual low-dose computed tomography, or CT scans,
based on evidence that showed the benefits of screening outweigh the
potential harms of over-diagnosis and overtreatment.
They gave screening a "B" recommendation, meaning the evidence of a
benefit is at least moderately certain. Under President Barack
Obama's Affordable Care Act, private insurers are required to cover
preventive services with a grade of "B" or higher without a copay.
The law does not require the Medicare health plan for people age 65
and older to do so.
The recommendation covers people aged 55 to 80 whose smoking has put
them at high risk of cancer, so a large proportion of patients
eligible for additional screening would be covered by Medicare.
A Medicare advisory panel on April 30 voted against covering the
tests, citing a lack of evidence. The panel's decision is not
binding, and Medicare is expected to issue a proposed coverage
decision by November 2014.
One reason for the panel's vote was a lack of evidence about cost,
Joshua Roth of the Fred Hutchinson Cancer Research Center in Seattle
told reporters on a conference call.
The study by Roth and colleagues was designed to help fill in that
gap. They used a mathematical model that calculated the cost of the
screening over a five-year period, based on three scenarios.
Under the most likely scenario, which assumes half of people who are
offered screening would get tested, doctors would order 11.2 million
more CT scans, resulting in nearly 55,000 more lung cancers detected
over five years versus no screening.
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The group estimates that the program would more than double the
proportion of cancers diagnosed at an early stage, increasing from
15 to 33 percent.
Including the cost of imaging, diagnostic work-up and care of newly
detected cancers, the program would cost Medicare $9.3 billion over
five years, amounting to an increase in Medicare spending of $3 per
member, per month.
A more conservative screening estimate that assumes 25 percent of
those offered would get screened each year would cost $5.9 billion
over five years, while a more aggressive scenario assuming 75
percent of those eligible would get screened would cost as much as
ASCO President Dr Clifford Hudis said the study is a model, "not
actual data," and stressed that while "low dose CT screening offers
a long-awaited early lung cancer detection strategy," doctors must
do everything they can to encourage patients to stop smoking and
keep young adults from starting.
(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and
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